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20160229 Permit Pkg 05262016City of Yelm Community Development Department Building Division Phone: (360) 458 -8407 Fax: (360) 458 -3144 Applicant: Name: DON KING Address: 1221 TOMAHAWK DR JBER AK 99505 Property Information: Site Address: 9905 GREENLEAF LP SE Assessor Parcel No.: 84070001500 Contractor Information: Name: DON KING Address: 1221 TOMAHAWK DR JBER AK 99505 Contractor License No.: Project Information: Project: DEMOLITION Description of Work: Sq. Ft. per floor: First Second Third Garage Basement Fees: Item DEMOLITION Contractor DON KING Subdivision: Permit No.: 201 60229 Issue Date: 5/26/2016 (Work must be completed within 180 days) Phone: 907 - 793 -7227 Owner: TYPE CURRENT OWNER NAME Phone: Expires: 0 /00 /0000 Heat Type (Electric, Gas, Other): TOTAL FEES: Applicant's Affidavit: I certify that I have read and examined the information contained within the application and know the same to be true and correct. I also certify that the proposed structure is in conformity with all applicable City of Yelm regulations including those governing zoning and land subdivision, and in addition, all covenants, easements and restrictions f rec rd. If applying as a contractor, I further certify that I am urrently registered in State of shi ton. Signature Z14, Date !Q Firm Lot: Fees $ 50.00 $ 50.00 OFFICIAL USE ONLY # Sets of Prints: Final Inspection: Date: By: Citj of Yelm (36 ) 458 -3244 REC #: 00232561 5/26/2016 OPER: CO 8:09 AM REF #: 23207 TERM: 001 PAID BY: IRAN: 33.0000 20160229 BUILDING PERMITS KING, DON 50.0008 DEMO 9905 GREENLEAF LP SE 50.00CR TENDERED: APPLIED: 50.00 (HECK 50.00- CHANGE: "�``- ---- 0.00 Olympic Region Clean Air Agency 2940 Limited Lane NW 111-0� n. jF Olympia, WA 98502 (360) 539 -7610 - FAX (360) 491 -6308 South Bend Office (360) 942 -2137 ORCAA Port Townsend Office (360) 338 -6419 www.ORCAA.org Demolition Permit 1-1 Emergency PROPERTY OWNER Name: Don King Phone: (808) 551 -4591 Email: dk8148 @gmail.com Mailing Address: City: State: Zip Site Address: 9905 Greenleaf Lp City: Yelm County: Thurston Zip 98597 DEMOLITION CONTRACTOR Contractor Name: Phone: Email: Site Contact Person: Jay Kobaza Phone: 3605073068 DEMOLITION INFORMATION # of structures being demolished: 1 tart Date: 5/24/2016 Expiration Dater 5/24/2017 Asbestos present? ❑ Yes WNo Survey attached? Yes No All identified asbestos was removed under Asbestos Permit # N/A DEMOLITION PROJECT CATEGORY Complete Demolition ❑ Training Fire Fire Agency, Contact, Phone: ❑ Renovation, Alteration, Remodeling, Maintenance, or other Construction I do certify that I am the owner, authorized agent of the owner, or authorized contractor for the property subject to this ORCAA application /permit. authorize ORCAA staff to enter the property listed in this application at reasonable times for purposes of inspecting the work that is the subject of this application /permit and to ensure compliance with permit conditions, applicable laws and regulations. I understand that granting of this permit by ORCAA does not authorize anyone to violate federal, state, or local laws or regulation pertaining to activities associated with this permit. I have read and will abide by the conditions set forth in this permit and any addendum thereto. I do certify under penalty of perjury under the laws of the state of Washington that the information in this application and supplemental data is, to the best of my knowledge true, accurate and complete. Electronically submitted by: Jay Kobza Permit Conditions Date Application Received 5/9/2016 Use Payment Info. © Approved Total Fee: $60.00 ❑ Disapproved Receive date: 5/9/2016 Review date: 5/18/2016 Reviewed by: CAD Agency Use Only Agency Use Only OVER Asbestos Permit: ' ermit # ASB Demolition Permit: ' ermit # 16DEM004369 Use RCAA Olympic Region Clean Air Agency 2940 Limited Lane NW Olympia, WA 98502 (360) 539 -7610 - FAX (360) 491 -6308 South Bend Office (360) 942 -2137 Demolition Permit Port Townsend Office (360) 338 -6419 www.ORCAA.org Demolition and renovation projects within Clallam, Grays Harbor, Jefferson, Mason, Pacific, and Thurston counties REQUIRE A PERMIT and require that the following conditions be met prior to the demolition. Olympic Region Clean Air Agency (ORCAA) regulations define a demolition project as the wrecking, razing, leveling, dismantling, or burning (by a fire department for training purposes) of a structure, making the structure permanently uninhabitable or unusable. Renovations include the removing of load bearing structural members, but not to the extent to make the structure uninhabitable. The following information is merely a reference guide and not a substitute for agency regulations. 11R good faith asbestos survey is required for any demolition. The survey must be conducted by a certified Asbestos Hazardous Emergency Response Act (AHERA) building inspector. Qualified contractors and inspectors may be found in your local Yellow Pages, through the Washington State Department of Labor and Industries, or on ORCAA's website. 2.Asbestos samples must be sent to a NVLAP Laboratory (National Voluntary Laboratory Accreditation Program) per 40 CFR 763.87. A list of labs can be found on ORCAA's website. 3.mhe start date on other structure demolitions must be at least 10 working days from the submission date of the complete application and payment. 4.111 is the responsibility of the property owner and /or demolition contractor to ensure there is no asbestos - containing material present in the structure to be demolished. 5.Any and all structures on the same parcel of property that are not proposed to be demolished must be identified as such. 6.A copy of the asbestos survey and approved Demolition Permit must be kept on site and be available for review by Agency inspection personnel. 7.1flhe original demolition permit will expire 1 year from start date. If the permit expires and the project is not complete, you must submit and pay for another demolition permit. Under no circumstances will a project be extended beyond 1 year from original start date. ADDITIONAL REQUIREMENTS: In addition to Agency requirements, most building departments require a demolition permit (separate from ORCAA's Demolition Permit). The Washington State Department of Labor Industries and the local fire authorities may also require notification for asbestos removal projects. "Owner Occupied Residential Dwelling" means any single family housing unit which is permanently or seasonally occupied by the owner of the unit both prior to and after the proposed project. This term includes houses, mobile homes, trailers, houseboats, and houses with 'mother -in -law apartment' or a 'guest room.' This term does not include structures that are demolished or renovated as part of a commercial or public project; nor does this term include any mixed -use building, structure, or installation that contains a residential unit, or any building that is leased or used as a rental, or for commercial purposes. CITY OF YELM RESIDENTIAL BUI LDING PERMIT APPLICATION FORM Project Address: 179 D 5 GreeGi ` /e9f 1 p Parcel #: Subdivision: Lot #: Plan #: Zoning: New Construction - -. Re -Model / Re -Roof / Addition I Home Occupation Sign Plumbing Mechanical -' Mobile / Manufactured Home Placement Other Project Description /Scope of Work: el/yl O Project Val Building Area (sq. ft) 15f Floor 2 "d Floor Garage Deck Basement Carport Patio # Bedrooms_ # Bathrooms_ Heating: GAS /OTHER or ELECTRIC (Circle One) Are there any environmentally sensitive areas located on the parcel? /f yes, a completed environmental checklist must accompany permit application. BUILDING OWNER NAME:_ ADDRESS CITY STA EMAIL dJ TELEPHON ARCHITECT /ENGINEER LICENSE # ADDRESS EMAIL CITY STATE ZIP TELEPHONE C0$4 GENERAL &O TRACTOR e PHONE ADDRESS mp i Y- t158 G L JKc18 -K i G, K L c OVC -Ccd�L CITY t STATE w/t ZIP _1&—L 3 FAX CONTRACTO 'S LICENSE #1 {o Z. I{l$ O /.Y'p WP DATE CITY LICENSE # PLUMBING CONTRACTOR TELEPHONE ADDRESS EMAIL CITY STATE ZIP FAX CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE # MECHANICAL CONTRACTOR TELEPHONE ADDRESS EMAIL CITY STATE ZIP FAX CONTRACTOR'S LICENSE # EXP DATE CITY LICENSE # Copy of mitigation agreement with Yelm Community Schools, if applicable. I hereby certify that the above information is correct and that the construction on, and the occupancy and the use of the above described property w'I be accordance with the laws, rules and regulations of the State of Washington and the City of Y � 5/-/ 6 Applic is S' nature Date Owne Con actor / Own 's Agent / Contractor's Agent (Please circle one.) All permits are non - transferable and will expire if work authorized by such permit is not begun within 180 days of issuance, or if work is suspended or abandoned for a period of 180 days 105 Yelm Avenue West taeu)vao -uooa Yelm, WA 98597 (360) 458 -3144 FAX www.ci.yelm.wa. us